S3610 Fully Covered Self-Expanding Metal Stent Improves Refractory Biliary Complications Including Perihepatic Abscess Following Partial Cholecystectomy

Introduction: Partial cholecystectomy is often performed in cases of severe acute cholecystitis when a complete cholecystectomy is not feasible, making it a necessary, life-saving choice. However, it carries long-term risks such as retained stones, biliary strictures, and intra or peri-hepatic abscesses. We present a case of recurrent biliary obstruction, strictures, and intrahepatic abscesses post-PC, successfully managed with endoscopic retrograde cholangiopancreatography (ERCP)-guided fully covered self-expanding metal stent (FCSEMS) placement. Case Description/Methods: An 80-year-old woman with a history of PC (2022) presented in 2024 with 7 weeks of right upper quadrant pain, fever, and weight loss. Imaging revealed gallstones in the gallbladder remnant, common bile duct (CBD) stones, a perihepatic abscess (1.7 cm) adjacent to the gallbladder fossa, and a distal CBD stricture. She initially underwent plastic stent placement, which was replaced multiple times for recurrent biliary obstruction, stricture progression, and eventually, stent migration. Despite multiple ERCPs with sphincterotomy and stone extraction performed from January to August 2024 using plastic stents, her symptoms persisted throughout. ERCP with cholangioscopy in October 2024 with biopsy revealed a fibrotic stricture and a migrated stent proximal to CBD stricture which was successfully removed. A 10 mm × 6 cm FCSEMS was deployed, resulting in immediate stone and sludge-filled biliary drainage. One week follow-up of the patient revealed marked symptomatic improvement and follow-up computed tomography in 6 months showed a reduction in abscess size (1.7 cm to 1.4 cm), stone clearance, and normalization of liver enzymes (ALT/AST: 16/22 U/L). The patient remained asymptomatic at the 6-month follow-up. Discussion: ERCP with cholangioscopy allows precise visualization of biliary strictures and is useful in assessing post-(PC) CBD complications. In our case, residual cystic duct remnants or gallstones likely triggered chronic inflammation, leading to fibrosis, stricture formation, and a perihepatic abscess. Post-PC complications were effectively managed with FCSEMS. Their anti-migration design, radial force, and long-term patency support stricture remodeling and sustained biliary drainage, reducing infection risk and aiding abscess resolution. FCSEMS provides a minimally invasive, definitive option for managing refractory biliary complications, especially in elderly or high-risk surgical patients. Early intervention may enhance outcomes and prevent recurrence.